Complaints process

The Commission receives and deals with complaints involving individual health practitioners, such as doctors, optometrists and acupuncturists, and health service organisations, such as hospitals.

Complaints about health organisations involve different procedures from those made about individual health practitioners. This is indicated in the two process flowcharts shown below.

To view more information for each step please move your mouse over the flowcharts below.

Complaint about
Health practitioner
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Complaint about
Health organisation
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Assessment
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1

Refer to professional council

2

Discontinue

3

Refer to another body

4

Resolved during assessment

5

Resolution Service

6

Formal Investigation
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7

Local Resolution

Investigation
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8

Prohibition order/public statement

9

Refer to professional council

10

Refer to the Director of Proceedings
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11

Make comments

12

Refer to the Director of Public Prosecutions

13

Terminate

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14

Make recommendations

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Monitor implementation of recommendations

No Prosecution
Prosecution

15

Complaint proved/not proved

 

Assessment

1. Refer to professional council

The commission can refer a complaint about a registered practitioner to the relevant professional council to consider taking action such as counselling, performance management or action regarding impairment.

2. Discontinue

The commission can discontinue dealing with a complaint for many reasons - for example, the time that has passed since the incident makes it difficult to investigate the complaint effectively.

3. Refer to another body

In some cases, the complaint may be referred to another body that is more suitable to deal with the issues of concern. For example, a complaint about non-authorised prescribing of addictive medications – so called scheduled drugs - may be referred to the Director General of the Ministry of Health. Allegations about over-servicing can be referred to Medicare Australia while the Commonwealth Department of Health and Ageing deals with complaints about conditions in nursing homes.

4. Resolved during assessment process

Complaints may be resolved during the assessment process where the person who made the complaint is satisfied with the information and explanation that the health service provider gives in their response.

5. Referred to the Commission's Resolution Service

Complaints can also be referred to the Commission's Resolution Service. A Resolution Officer can assist the parties to resolve any outstanding issues. In some cases, an independent conciliator facilitates a meeting.

6. Investigation by commission

The Commission formally investigates complaints that raise a significant issue of public health or safety, or, if substantiated, provide grounds for disciplinary action against a registered health practitioner.

7. local resolution

Minor complaints about a public heath organisation can be referred back to the organisation to try to resolve the matter locally with the person who made the complaint, if the organisation agrees to this.

Investigation

8. public statement/order

Issue a prohibition order, public statement and/or public warning. A prohibition order can ban or limit an unregistered health practitioner from providing health services. The practitioner must advise potential patients of any limitations imposed before treating them. A breach of the order is a criminal offence. The Commission can also issue a public warning where it has found a treatment or health service to be unsafe.

9. Refer to a professional council

Refer the complaint to a professional council to take action, including assessing the practitioner for performance or impairment, or counselling them about their conduct.

10. Refer to director of proceedings

Refer the complaint about a registered practitioner to the Director of Proceedings who determines whether or not it should be prosecuted before a disciplinary body. The Director of Proceedings must consider the protection of the health and safety of the public; the seriousness of the alleged conduct; the likelihood of proving the alleged conduct; and any submissions by the practitioner when making this determination. If the Director of Proceedings decides not to prosecute a matter, it may be referred back to the Commissioner to consider other appropriate action. If a matter is being prosecuted, complaints about unsatisfactory professional conduct will usually be heard by a Professional Standards Committee, while a complaint about professional misconduct will be prosecuted before the NSW Civil and Administrative Tribunal.

11. Make Comments

Make comments. The Commission makes comments to registered health practitioners where there was poor care or treatment, but not to an extent that would justify prosecution. Comments can also be made to an unregistered health practitioner where although the conduct can be improved, there is no risk to public health or safety. Comments to a health organisation are made in cases where the health care provided was inadequate, but the organisation has already taken measures to prevent a similar occurrence in the future.

12. Refer to the Director of Public Prosecution

Refer the matter to the Director of Public Prosecutions to consider criminal charges.

13. Terminate the investigation

Terminate the complaint (take no further action) where the investigation has found no or insufficient evidence of inappropriate conduct, care or treatment.

14. Make Recommendations

Make recommendations to a health organisation where there has been poor health service delivery and systemic improvements should be made. The Commission also provides its recommendations to the Director General of the Ministry of Health and the Clinical Excellence Commission to inform their work in improving health services.

14. (Monitoring) Make Recommendations

The Commission monitors whether its recommendations to a health organisation have been implemented. If the Commission is not satisfied with the implementation, it may, ultimately, make a special report to Parliament.

Prosecution

15.Proven

A Professional Standards Committee or Tribunal that finds the complaint proven can reprimand, fine and/or impose conditions on the practitioner. Only the NSW Civil and Administrative Tribunal can suspend or cancel the registration of a practitioner. The Tribunal may also issue a prohibition order that bans or limits a practitioner from practising in another area of health service – for example, a psychiatrist whose registration is cancelled can be banned from working as a counsellor.